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Tuesday, January 4, 2011

Where Does Obligation End? Part 2

Back in November I started the most recent poll, asking if veterinarians had an obligation to provide treatment for a pet even if the owner couldn't afford it.  The question was based on a situation with a client, and though it was one of the more extreme situations I've seen, it wasn't the first one on this subject.  The results of the poll surprised me somewhat, as I didn't expect such a large percentage to say a vet has an obligation to treat.

No--56%
Yes--30%
I'm Not Sure--12%

I think that many people don't realize how much money it takes to run a veterinary practice.  Most vets run on a slim profit margin, and it's not uncommon for veterinary clinics to go out of business.  The most common reasons for such failure usually revolve around the vets not charging for services, giving away services, or having too low prices.  While it may seem nice to a client to have low veterinary prices, these low prices often come at the cost of the veterinarian.  Not charging and keeping prices too low are key reasons for vets to end up in a failed business, and ending up having to close their doors.

Veterinary practices are expensive.  Routine in-house blood analyzers can cost over $20,000.  An electronic tonopen, used for measuring eye pressure during glaucoma screens, runs around $3000.  My practice usually spends $2000-3000 per week ordering routine supplies, vaccines, and medications (and we're an average practice, not a really big one). About 40-45% of our monthly budget goes into meeting our payroll.  Each month we have to pay rent, utilities, unemployment insurance, liability insurance, benefits for the staff, data and phone lines, and a long list of other expenses that most people don't think about.  We are a profitable practice, but there isn't a lot of wiggle room.

So let's say that we took the obligation to treat all pets, even if the owner couldn't afford it.  When we're using medications, bandaging, surgical supplies, and so on to treat pets for free, it still costs our business to order them.  We still have to pay all of our obligations.  I can't call the phone company and say "We gave away about $1000 in services to needy pets this month. We're a little short on our phone bill.  Can you give us a break this month?"  I'm not sure my staff would stick around long if I told them I couldn't pay them for their hours worked because we did a lot of charity services this week.  And I wouldn't get far with our suppliers if I wanted to order more things but hadn't brought in enough money to do so. We have expenses and bills regardless of how much money comes in.  When we lose more money than we make we have to close he business.  And who can we help in those situations?

It's really nice to wish that we could see any pet and treat it.  But the reality is that this is not sustainable. I know that many of the people who voted were likely thinking of their own pets, and looking at themselves as the exception.  "Well, the vet makes enough money I'm sure he could afford to absorb a few hundred dollars for my pet."  Once in a while this may be the case, and I don't have a problem with vets who do occasionally help out clients by writing off costs or allowing payments.  But this can't be maintained by any vet.  And remember that there are many people who want the same consideration.  If the poll numbers are representative, 30% of the clients are expecting the other 70% to help pay for their medical care.   Or looking at it another way, veterinarians are being expected to keep their high level of medical quality and services, but doing so with 30% less income.  It simply can't be done.

So here's my question for anyone who voted "Yes" to the question "Do veterinarians have an obligation to treat a pet even if the owner can't afford it?"  How are the veterinarians supposed to pay their bills and stay open if they treat every pet without regards for payment or compensation?

11 comments:

  1. Honestly, I understand your position, but I hope you do at least offer euthanasia free of charge in the event of an animal that is in such a dire state that it would be more humane to put it down than to leave it untreated due to a client's lack of finances.

    That said, my own veterinarian has been kind to me financially a time or two when I was unable to pay. But I have a history with her, and had always paid my bills prior to that point, so that may have had something to do with that. I know that she doesn't do this for clients often, and she told me to not talk about it to any one else that may be a client. And I have stuck to that. Her practice has done well for years. Perhaps veterinarians could be obligated to "give a break" to clients who have proven themselves? Or perhaps even a limit could be set - 3 pro bono treatments and then you won't do it anymore. etc.

    What I have never understood is why veterinarians do not offer people the chance to work down what is owed. Surely there are menial tasks or chores that need doing that they could do? Basic office work? Stuff that you'd normally pay someone to do?

    Also, why not start a fund of some sort that clients can donate to, to pay for services for clients who can't afford it? You might be surprised. You could even arrange events to help get donations, like a pet fashion show, raffles, etc.

    And even let clients work off what they owe by organizing these events. lol

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  2. I saw the poll after voting has ended and personally I would've said the vet doesn't have an obligation. Making sure that you have finances available even in emergencies is one of the things you have to take into consideration before getting a pet.

    There are options that exist if you can't afford it. Different animal rescues and charitable organizations are willing to make some donations if you ask. I've even seen people ask on Craigslist only to post again to thank people for the support. I worked at a small clinic (not a vet clinic) and we didn't post this out but if you're an established client things like payment plans can be worked out. From working at the clinic I realized how expensive it can be to run a practice and yes, people will try to take advantage of you so I really have to say it's unfair to think that someone should have to cover your vet bills. It can be expensive yes but it's part of the duties of being a pet owner.

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  3. If the last 2 years with this economy have taught us nothing else, it's that you can plan everything out and still have it all come crashing down. Not having funds for emergency care doesn't necessarily mean you got a pet when you knew you couldn't do it - perhaps at one time you could have covered any issue with the pet easily but since getting the pet, something happened to make it so you can't. Cats and dogs live for a very long time, and even if you can bear to rehome them for their own sake, it's hard to find someone to take them in.

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  4. To the first anonymous poster...I think you hit on a very important point. If you have a trusted relationship with your veterinarian, there are often payment plans or some arrangements that can be worked out.

    Unfortunately, far too many people do not maintain that relationship (as you appeared to do) and then expect any veterinarian to offer a payment plan. It's no different from walking up to someone on the street and saying "Hey, you don't know me, but I need $1000. Will you give it to me?"

    Similarly, you mention having people "work" down their bill. It's the same thing...what happens when that client works for two or three days and then just stops showing up?

    The bottom line is exactly what Dr. Bern mentions in his blog. It costs money to treat pets and that money needs to come from somewhere. For every person that asks for a discount, pro bono services, or a payment plan, there are multiple employees of that veterinary hospital that will be impacted in some way.

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  5. >>I hope you do at least offer euthanasia free of charge>>

    Sure, and it's heartbreaking... for veterinarians. I hate euthanasia when the animal could potentially be treated.

    >>Her practice has done well for years.>>

    Actually, unless you've seen her tax returns, you don't know how "well" your veterinarian's practice is doing.

    Until the recession, I had no idea how "well" the veterinarians practicing in my region were doing. Over the last two years: three came out of retirement (ages 67+) when their investments tanked. Two did not renew associates' contracts, because they couldn't afford to keep them. Many began to moonlight, working part-time shifts at emergency clinics, as relief veterinarians, or for corporate practices. One declared bankruptcy. I thought all of these veterinarians were financially stable. I also know all of them have given away services - just like me, and I barely hung on.

    >>Perhaps veterinarians could be obligated to "give a break" to clients who have proven themselves? Or perhaps even a limit could be set - 3 pro bono treatments and then you won't do it anymore. etc.>>

    How self-centered. In a word: no. Veterinary medicine is a private business. Think of it this way: you aren't obligated to own pets. If you can't pay the veterinarian, don't have any pets, or keep only one or two. Know your limit.

    Also: 95% of my clients have "proven themselves". You are NOT more worthy of financial consideration than your veterinarian's other clients.

    >>What I have never understood is why veterinarians do not offer people the chance to work down what is owed. Surely there are menial tasks or chores that need doing that they could do? Basic office work? Stuff that you'd normally pay someone to do?>>

    Are you serious? Here we go:

    1. If a client does work normally done by one of my paid employees, what should my employee do? Should I cut the employee's hours that week?

    2. Office work = client medical and financial records. Do you really want fellow clients who are not my regular employees to have access to your personal business, including the fact that you occasionally can't pay your bills?

    3. The potential liability of allowing a non-employee anywhere near patients (including cleaning cages) is enormous. Urine and feces can transmit disease in certain instances, for example, and an untrained person is far less likely to observe accepted precautions.

    4. Most of my records are computerized, and the program is not terribly intuitive. Who is supposed to teach the client how to use the system, and how should that person be paid for her time?

    If I sound unsympathetic, well, it's because I'm working on my 2010 taxes. For the third year in a row, it's not good news.

    My advice to you: this year, figure out an annual budget for routine veterinary care. Open a separate account for your animals and sock away a little extra away each month for unexpected expenses. Call the local emergency clinic and find out the average cost for hospitalization so you'll have a target figure in mind.

    Stop thinking of your kind, helpful veterinarian as a bank. She'd much prefer to treat your animals without worrying about how much pro bono work she did last year.

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  6. I completely agree with A DVM in response to the first Anonymous post. I work for a veterinary hospital (which I will be purchasing after graduation from vet school next year) and we charge the least out of the vets in the area - by far. But in return, we have an extremely high volume practice. Yes, we could charge more and see/help less clients - but that wasn't what the practice was built on. We have so many great clients - but it would be impossible to provide free vet care to all of those clients that truly deserve it.

    Anonymous, it truly is a little ignorant what you are proposing. Do you go to a restaurant, eat the food, and realize you have no money so you ask to wash dishes in the kitchen? It isn't feasible. Plus, these "fundraising/donation" events you propose - Do you see medical doctors out there selling cookies in a bake sale to help out their patients who can't pay their bills? I don't mean to attack, but it is people like you that simply don't understand that veterinarians are required to be more than doctors - but business men and women as well.
    Additionally, veterinarians accumulate a similar debt load as that of medical doctors - but we don't make NEARLY the same annual income - it takes a very long time to pay off that debt. That theoretical pro-bono treatment that we just gave to a good client could be six months worth of my student loan bills...

    sigh.

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  7. I didn't vote that the vet should treat my pet even if I cannot afford it - but I did just want to say that after reading these two articles and the responses from some other veterinarians and those that have worked in vet offices - I am even more convinced we as pet owners shouldn't expect "deals" or "breaks". Before I read this, I didn't really think about the costs associated with keeping a clinic running. I used to have both of my dogs into my vet office so often - I would joke to my friends that I should have my own parking space or that I was probably paying for the vet's vacation. The vet office that I have used for the last 10 years has recently gone through a bankruptcy and that was a real eye opener. Thankfully the clinic remains open (and I no longer inwardly complain/groan about the costs associated with the visits).
    I am one of the people that would fall into the category of being financially secure when I first adopted my two dogs, but since then things have been tight. However, I have done what was necessary to make sure my dogs have had proper preventative and other emergency/unplanned care as needed - even if it involved having to cut luxuries in my own life (internet, certain phone extras, cable, eating out, etc); I have even asked family to lend me money at one time or another. It's amazing to me how many people that own pets will not cut out "stuff" in their own lives to provide just basic veterinarian care for their pets. These same people will say they “love” their pets – but their actions do not always support that statement.
    It seems that we as a society have made it almost commonplace to expect the world to give us handouts when things get tough and we are actually inappropriately indignant when that doesn’t happen. It is a mystery to me why some folks think they are entitled to receive “special consideration” when it comes to vet care. While our society has made it fairly routine for those with financial struggles to obtain free health care for children and/or adults – until there is a free vet care clinic – reconsider adopting an animal you are not financially willing or able to care for. Do not expect a veterinary clinic to financially support your pet that you chose to bring into your family.

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  8. This is such a touchy subject and it's great to read everyone's personal opinions. I recently saw an article discussing the cost of veterinary care and directly comparing two very similar surgeries on a dog and a human. The author, a DVM, calculated pound-for-pound the costs of both surgeries and the human surgery was about 16 times more pricey than the canine surgery. I really wish more people understood the financial burdens of veterinarians. It's as simple as putting some money aside each month for your pet's health, much like any other investment.

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  9. I am not a veterinary practitioner, so by no means am I an expert on it. However, when we have a child, and are able to support them through most injuries/normal hospitalizations, but we have trouble for example if they are suddenly diagnosed we cancer, are we expected to have predicted/prepared for the thousands of dollars the treatment now costs? No, we rely on insurance to pay most of it, but pet insurance doesn't seem to be as extensive or supportive (correct me if I'm wrong). The main difference between pets and humans is when a life threatening illness comes up, we attempt to help the person as much as possible, but are more inclined to ending the life of a pet. However, I agree, asking for a "pro-bono" on an ordinary surgery, like a dental cleaning, is out of the question and irresponsible of the owner.

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  10. >>The main difference between pets and humans is when a life threatening illness comes up, we attempt to help the person as much as possible, but are more inclined to ending the life of a pet.>>

    Yes, we are inclined to end the life of a pet, because euthanasia is a humane and viable option in veterinary medicine.

    I do not understand your point. Who should pay for unexpected medical expenses for treatment (vs. euthanasia) of a pet, if not the owner?

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  11. I believe the problem here is not just vet's hiked-up prices (charging more for flea treatments etc.), but the medical companies for charging so much in the first place. It's ALL about money, for both human and veterinary medicine. Flea treatments contain micrograms of active ingredients, yet they are £7 a go and most don't even work! I know it costs money to produce medicines, but this is not an industry which should be propelled by cash as this can be a corrupting factor. I don't take any medications and haven't done for over 10 years because I no longer trust it. There is a darker side to medicine which is particularly concerning when it's such an emotional field.

    Whilst some of the comments have helped me understand the vet's point of view, I maintain that there are times when you are being ripped off. Why not get a charity funding option? I know if I was flush with money and sAT in the vet's waiting room, I would happily donate towards a fund for people who could not afford treatments. This might also get the practice some charity breaks (although I'm not sure how it works).

    With regards to Anonymous' comment, I don't think people have truly understood the point that whilst their suggestions were impractical, it did show what people were willing to do in order to afford these treatments and how serious they are about getting them. It shows the levels of desperation we reach when helping our pets and that we don't want to be rendered helpless in a situation where someone we love might die or suffer. For those who optimistically suggest this simply means cutting out 'cigarettes or beer' (as one condescending commenter suggested in 'part 1'), saving for an emergency is very difficult on a low income. To suggest you shouldn't have pets if you can't afford them is equally naive. There are so many animals in need of homes (we adopted our 2 cats) that food and a roof is sometimes most important.
    When it comes to treatment, we scrape together what we can.

    However, whilst we understand that vets have bills to pay, likewise, so do we and we would go bankrupt too should we pay their sometimes extortionate fees. As with any business, if they over-charge or skimp on quality, we won't use their services. My vet commonly over-charges for things, such as Elizabethan collars and bandages, but they don't tell clients this is where their money is going. When someone is struggling to pay, these prices should be minimal or clients should be informed they could cut costs by buying particular things elsewhere. With a breakdown of costs, I tell you now I wouldn't pay £8 for a plastic collar I could make myself or buy online! It reminds me of the time I took my cat in for a small cut on his tail. We saw the nurse and simply wanted to know if the cut was dangerous enough to require treatment. Before I knew it, she was loading up vaccines to inject my cat with, without telling me what they were, how much they cost or whether or not they had side-effects. Of course, I stopped her to find it was an anti inflamatory and a pain killer- both unnecessary and expensive. On telling her my cat was not in pain (trust me, he'd let me know), she looked at me like I was Hannibal Lecter himself to deprive my beloved pet an unnecessary, potentially dangerous and overly expensive shot of pain killers (£7 per shot JUST for the administration, not including the cost of the shot itself).

    Oh and my cat was fine, as expected, they heal very quickly :)

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